Respiratory System Nursing Care

• The respiratory system's structure and function are reviewed, including respiration and acid-base balance.
• Smoking cessation interventions, breathing exercises, and incentive spirometry are explained.
• Chest tube drainage systems – operation, troubleshooting – are discussed.
• Nursing care for patients on mechanical ventilation is provided.

Effects of Aging

• Aging affects the respiratory system.

Acid-Base Balance

• Respiratory acidosis results from hypoventilation.
• Respiratory alkalosis results from hyperventilation.
• WHAT'S UP? is used to assess respiratory issues: Where is it? How does it feel? Aggravating and alleviating factors? Timing? Severity? Useful other data? Patient’s perception?

Inspection

• Symmetry, dyspnea, use of accessory muscles, and color are assessed.
• Respiratory rate and rhythm, and chest shape are noted.

Auscultation

• Normal and adventitious breath sounds are assessed bilaterally.

Adventitious Breath Sounds

• Crackles can be coarse or fine.
• Wheezes, stridor, and friction rubs are examples of abnormal breath sounds.
• Diminished or absent breath sounds may be present.

Laboratory Tests

• Complete blood count, arterial blood gases, D-dimer, culture and sensitivity (sputum, throat, nasal), oxygen saturation, and capnography are performed.

Diagnostic Tests

• Chest x-ray, computed tomography (CT) scan, ventilation-perfusion scan, pulmonary function studies, pulmonary angiography, and bronchoscopy are used.

Therapeutic Measures

• Deep breathing and coughing are implemented.
• Huff coughing and autogenic drainage are used.
• Breathing exercises include diaphragmatic and pursed-lip breathing.
• Positioning includes Fowler's, Semi-Fowler's, and "good lung down."

Oxygen Therapy

• Nasal cannula, oxygen masks (simple, partial rebreather, nonrebreather, Venturi), and transtracheal catheters are used.

Oxygen Masks

• Simple mask, partial rebreather mask, nonrebreather mask and Venturi mask

Transtracheal Oxygen

• Oxygen is given through the trachea.

Nebulized Mist Treatment

• Medication is given in a mist form that is inhaled.

Metered-Dose Inhaler

• Medication is inhaled using a device.

Spacer

• A spacer can be used with a metered-dose inhaler.

Vibratory Positive Expiratory Pressure (PEP) Device

• Vibrations are used when exhaling.

Smoking Cessation

• Behavior modification, counseling, setting a quit date, nicotine replacement, drug therapy, hypnosis, physical activity, and e-cigarettes are options.

Pursed Lip and Abdominal Breathing

• Inhale deeply through the nose, feeling the abdomen expand.
• Hold the breath for a few seconds and exhale slowly through pursed lips, feeling the abdomen deflate.

Incentive Spirometer

• A device used to encourage deep breathing.

Chest Drainage

• Indications, chest tube insertion, drainage system, and nursing care are involved.

Chest Drainage System

• A system to drain fluid or air from the chest.

Chest Drainage Data Collection

• Data collection includes patient assessment, tubing, drainage system, water seal chamber, suction chamber, and drainage chamber.

Intubation

• Inserting a tube into the trachea.

Mechanical Ventilation

• Can be invasive.
• Indications for use and troubleshooting alarms are important.
• Nursing care includes checking advance directives, using a team approach, monitoring the patient, keeping the head of bed raised 30 to 45 degrees, providing oral care with chlorhexidine, suctioning as needed, and assisting with communication.